Glomerular Capillary and Endothelial Cell Injury is Associated with the Formation of Necrotizing and Crescentic Lesions in Crescentic Glomerulonephritis
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- Fujita Emiko
- Department of Nephrology, Nippon Medical School
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- Nagahama Kiyotaka
- Department of Analytic Human Pathology, Nippon Medical School
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- Shimizu Akira
- Department of Analytic Human Pathology, Nippon Medical School
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- Aoki Michiko
- Department of Nephrology, Nippon Medical School Department of Analytic Human Pathology, Nippon Medical School
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- Higo Seiichiro
- Department of Nephrology, Nippon Medical School Department of Analytic Human Pathology, Nippon Medical School
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- Yasuda Fumihiko
- Department of Nephrology, Nippon Medical School Department of Analytic Human Pathology, Nippon Medical School
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- Mii Akiko
- Department of Nephrology, Nippon Medical School
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- Fukui Megumi
- Department of Nephrology, Nippon Medical School
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- Kaneko Tomohiro
- Department of Nephrology, Nippon Medical School
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- Tsuruoka Shuichi
- Department of Nephrology, Nippon Medical School
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Background: The associations of glomerular capillary and endothelial injury with the formation of necrotizing and crescentic lesions in cases of crescentic glomerulonephritis (GN) have not been evaluated in detail. Methods: Glomerular capillary and endothelial cell injury were assessed in renal biopsy specimens of crescentic GN, including those from patients with anti-neutrophil cytoplasmic autoantibodies (ANCA) -associated GN (n=45), anti-glomerular basement membrane (GBM) GN (n=7), lupus GN (n=21), and purpura GN (n=45) with light and electron microscopy and immunostaining for CD34. Results: In ANCA-associated GN, anti-GBM GN, lupus GN, and purpura GN, almost all active necrotizing glomerular lesions began as a loss of individual CD34-positive endothelial cells in glomerular capillaries, with or without leukocyte infiltration. Subsequently, necrotizing lesions developed and were characterized by an expansive loss of CD34-positive cells with fibrin exudation, GBM rupture, and cellular crescent formation. With electron microscopy, capillary destruction with fibrin exudation were evident in necrotizing and cellular crescentic lesions. During the progression to the chronic stage of crescentic GN, glomerular sclerosis developed with the disappearance of both CD34-positive glomerular capillaries and fibrocellular-to-fibrous crescents. In addition, the remaining glomerular lobes without crescents had marked collapsing tufts, a loss of endothelial cells, and the development of glomerular sclerosis. Conclusions: The loss of glomerular capillaries with endothelial cell injury is commonly associated with the formation of necrotizing and cellular crescentic lesions, regardless of the pathogeneses associated with different types of crescentic GN, such as pauci-immune type ANCA-associated GN, anti-GBM GN, and immune-complex type GN. In addition, impaired capillary regeneration and a loss of endothelial cells contribute to the development of glomerular sclerosis with fibrous crescents and glomerular collapse.
収録刊行物
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- 日医大誌
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日医大誌 82 (1), 27-35, 2015
日本医科大学医学会